What Is the Optimal Delay Interval between Myocardial Infarction and Needed Noncardiac Surgery?

Glance LG, Joynt Maddox KE, Thomas S, et al. Time Since Prior NSTEMI and Major Adverse Cardiovascular and Cerebrovascular Events After Noncardiac Surgery. JAMA Surg. 2024, in press.

Smith E, Young L, Bakaeen FG. The Ongoing Dilemma of Timing Noncardiac Surgery after NSTEMI. JAMA Surg. 2024, in press.

This study noted that current guidelines for determining the best delay interval between myocardial infarction and needed noncardiac surgery are more than 20 years old. Using data from the Medicare claims database, the authors sought to determine the safest period of delay for patients requiring noncardiac surgery following myocardial infarction.

The sample included 5,227,473 surgical patients; myocardial infarction occurred in 42,278 patients. The outcomes of interest were 30-day mortality and major adverse cardiovascular and cerebrovascular events (MACCE).

Patients undergoing surgery within 30 days of a myocardial infarction had increased odds of MACCE regardless of whether revascularization had been performed. MACCE risk leveled after 30 days following revascularization and after 90 days if a drug-eluting stent had been placed.

The risk of MACCE leveled after 90 days for emergency procedures and remained elevated in patients who had not undergone revascularization procedures.

The authors recommended that surgery be delayed for 90–180 days following myocardial infarction.

In the editorial that accompanied the article, Smith and coauthors noted that a limitation of the study was that myocardial events were not separated according to type (type 1: plaque rupture, type 2: mismatch between oxygen supply and demand). Type 2 patients have varying etiologies leading to myocardial infarction and are much less likely to undergo drug-eluting stent placement. Despite these limitations, the recommendations are valuable. Further studies should stratify patients to more accurately determine the safest delay interval.